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5203 Sharon Rd Charlotte NC 28210-4721 | |
| (704) 554-9900 | |
| (704) 554-9956 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5203 Sharon Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Sharon Combs (BUSINESS MANAGER) |
| Authorized Official Contact | 7045549900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5203 Sharon Rd Charlotte NC 28210-4721 Ph: (704) 554-9900 | 5203 Sharon Rd Charlotte NC 28210-4721 Ph: (704) 554-9900 |
| NPI Number | 1871679464 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 08/27/2024 |
| Certification Date | 08/27/2024 |
| Medicare PECOS PAC ID | 2264971779 |
|---|---|
| Medicare Enrollment ID | O20240828003849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871679464 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | John C Simpson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871534065 PECOS PAC ID: 6305911009 Enrollment ID: I20080814000474 |
| Provider Name | Patrick Falvey Collins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487060059 PECOS PAC ID: 4082993894 Enrollment ID: I20161118001914 |
| Provider Name | Daniel B Miles |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255982864 PECOS PAC ID: 5294274726 Enrollment ID: I20240828005067 |
| Provider Name | Mary Gail Frawley-o'dea |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558433110 PECOS PAC ID: 6709325145 Enrollment ID: I20240828005112 |
| Provider Name | Amanda M Jamison |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891121778 PECOS PAC ID: 0345789855 Enrollment ID: I20240829000075 |
| Provider Name | Perry R Griffin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457724882 PECOS PAC ID: 0345772711 Enrollment ID: I20241010002922 |
| Provider Name | Jessica G Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164093647 PECOS PAC ID: 4082146071 Enrollment ID: I20241015004007 |
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